A 76-Year-Old Man Comes to the Office Due to Constipation

A 76-year-old man comes to the office due to constipation.  He has infrequent bowel movements associated with straining during defecation.  In addition, the patient has intermittent fecal leakage and hematochezia but no melena or unexpected weight loss.  Medical history is notable for prostate cancer treated with external beam radiation and brachytherapy 18 months ago.  Follow-up CT scans and prostate-specific antigen levels show no evidence of cancer recurrence.  Temperature is 37.5 C (99.5 F) , blood pressure is 132/80 mm Hg, pulse is 80/min, and respirations are 12/min.  Conjunctival pallor is present.  Cardiopulmonary examination is unremarkable.  The abdomen is soft and nontender.  Colonoscopy reveals rectal pallor with areas of mucosal hemorrhage and telangiectasias; the rest of the colon is unremarkable.  Which of the following is most likely contributing to this patient's symptoms?

A) Chronic inflammation of the mucosa and submucosa
B) Electrolyte abnormalities
C) Parasympathetic nervous system dysregulation
D) Pelvic floor dyssynergia
E) Progressive rectal fibrosis

Correct Answer:

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